Update on Drug Testing Procedures

1/28/2016

Beginning January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) deleted all 2015 drug testing  G codes and will continue to not recognize the AMA CPT codes for drug testing.

BMS will follow the CMS coding guidelines for reporting drug testing procedures:

  • Submit drug testing services to BMS using CMS codes G0477-G0483
  • Only one of the three presumptive codes (G0477, G0478, G0479) may be billed per day.
  • Only one of the four definitive codes (G0480, G0481, G0482, G0483) may be billed per day.
  • Only one service unit per procedure code per date of service may be billed when submitting G0477-G0483
  • Drug confirmation tests are no longer eligible to be separately reported under any procedure code, unlisted or otherwise.  This service is considered included in the presumptive or definitive drug testing procedure codes (G0477-G0483)
  • Specimen validity testing is not eligible to be separately billed under any procedure code.  The code description for G0477-G0483 indicates that this testing is included if it was performed.

BMS policy will continue to require a prior authorization for drug screenings performed for over the limit of 30 per calendar year.  The HF modifier must continue to be included on all claims for these codes when related to substance abuse treatment. (e.g. Suboxone).

 


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